TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2018 | Volume:76 | Issue:5 |Papers Count:11

The cartilage is a connective tissue that, due to the strength of its extracellular matrix, allows the tissue to tolerate mechanical stress without undergoing permanent deformation. It is responsible for the support of soft tissues and due to its smooth surface and elasticity, gives the joints the ability to slip and bend. excessive weight, excessive activity, or traumacan all cause cartilage to injury. The injury can lead to swelling, pain and varying degreesof mobility loss. The process of repairing musculoskeletal (orthopedic) injuries has led toproblems in the medical field, which can be attributed to the inherent weakness of adultcartilage tissue. Therefore, this necessitates research focused on the development of a newrestructuring strategy by combining chondrocytes or stem cells with scaffolds and growthfactors to address these problems. Correspondingly, the recent tissue engineering strategiesstrongly support the simultaneous use of stem cells, scaffolds and growth factors. Ithas also been observed that due to the relatively low proliferation of transplanted chondrocytes, new cartilage models construction have examined the use of adipose-derivedstem cells. Mature adipose tissue is produced as an important source of multi-functionalstem cells that can be easily separated from the stromal vascular fraction (SVF) by adiposeliposuction digestion. The adipose-derived stem cells are easily accessible withoutany serious complications and have the power to differentiate into several cell lines, includingchondrocytes as well as, they evidence self-renewal when trapped in gel scaffoldssuch as collagen. Also, recent studies demonstrate some of the mechanisms involved inthe process of making cartilage of adipose-derived stem cells in vitro and their restorativeability in bio-engineered scaffolds in the presence of growth factors. In addition, the importantrole of non-encoding mRNA molecules (miRNAs) has been identified in the processof chondrogenic differentiation of adipose-derived stem cells. Furthermore, in severalstudies, the effect of several miRNAs has been confirmed on the regulation of the cartilagedifferentiation of the adipose-derived stem cells and has also been associated witheffective results. In this article, we will present an overview of the advance in adiposederivedstem cells application in cartilage regeneration.

The natural killer group 2D (NKG2D) is a transmembrane protein and a member ofthe CD94/NKG2 family of C-type lectin-like receptors. NKG2D is encoded by theKLRK1 gene, which is located in the NK-gene complex (NKC) placed on chromosomes6 and 12 in mice and humans, respectively. NKG2D forms a homodimer structure andbinds through ectodomains with its related ligands. Each of its monomers consists of twoβ-sheets, two α-helices, and four disulfide bands and also contains a β-strand that distinguishesit from other C-type lectin-like receptors. NKG2D ligands are homologs of majorhistocompatibility complex (MHC) class I molecules in mice and humans. MHC class Ichain-related protein A (MICA) and B (MICB) and human cytomegalovirus UL16-binding proteins (ULBP1-6) are recognized by the human NKG2D. In Natural Killer(NK) cells, NKG2D-mediated cytotoxicity can be elicited via two different systems bysignaling from immunoreceptor tyrosine-based activation motifs in DAP12 or via a Sykindependentpathway activated by DAP10. Therefore, NKG2D is an activating immunoreceptorwhich was first recognized on NK cells but subsequently found on γ δ T cells, CD8+ α β T cells, and macrophages. NKG2D-ligand diversity may facilitate the detectionof the presence of a broad range of viruses and may provide protection against rapidlyevolving cancers. NKG2D ligand recognition induces and/or improves immune responsesto cancer cells. NK cells recognize a wide range of stressed cells. The activation ofNKG2D receptor can lead to the lysis of the target cell and the production of various cytokinesand chemokines depending on the nature of the stimulation as a result of NK andmyeloid-mediated innate immunity and as well as T γ δ and CD8+ mediated-adaptive immunesystem. However, inappropriate expression of NKG2D ligands could cause autoimmunediseases in healthy cells, including rheumatoid arthritis, colitis, celiac disease, multiple sclerosis, alopecia areata, type 1 diabetes, and chronic obstructive pulmonarydisease. Therefore, a precise understanding of the structure and function of NKG2D receptorand its interaction with various ligands may lead to the development of strategiesto treat autoimmune diseases. Hence, the purpose of this review is to examine the detailedstudies on the function of NKG2D receptor and their related ligands.

Background: Recent evidence suggests that regular exercise training is effective intreating various aspects of cancer. Therefore, the purpose of this study was to determinethe effect of 8 weeks of aerobic interval training on monocarboxylate transporter 1(MCT1) protein and expression of p53 gene in tumor of colon cancer mice. Methods: The present study was conducted experimentally from May to October 2014at the Exercise Physiology Research Center of Baqiyatallah University of Medical Sciences, Tehran, Iran. Twenty BALB/c mice of age 3 weekly with a mean weight of17. 6± 1. 4 grams were selected and randomly divided into 4 groups: control (N=5), intervaltraining (N=5), colon tumor (N=5) and interval training+colon tumor (N=5). Thecancer was induced by subcutaneous injection of a carcinogenic azoxymethane (10mg/kg) once a week for three weeks, and aerobic exercise was performed with rodenttreadmill for 8 weeks and 5 days a week. Forty-eight hours after the last training session, the mice were cleared and colon removed. Measurement of MCT1 protein wasperformed by ELISA and commercial kits (ZellBio, Germany). Real-time polymerasechain reaction (PCR) was used to determine the relative expression of p53 gene. Datawere analyzed by Kruskal-Wallis test and Mann-Whitney U tests. Results: The results showed a significant increase in MCT1 protein (P< 0. 01) and significantreductions in p53 gene expression (P< 0. 001) in a colon tumor group comparedto other groups. Also, there was a significant decrease in the level of MCT1 protein(P< 0. 01) and significant increase in p53 gene expression (P< 0. 001) in the exercisetraining group and exercise training+colon tumor group compared to control group andthe tumor group was observed. Conclusion: The findings of the study showed that aerobic interval training reduced theprotein content of MCT1 and increased the expression of p53 gene (as a tumor inhibitor)in the tumor of colon cancer mice. These factors are portions of the mechanismsinvolved in cancer cell metabolism by which aerobic interval training shows part of itstherapeutic effect in colon cancer.

Background: Immunoglobulins are a group of proteins have important role in defenseagainst microorganisms. Human immunoglobulins are divided into five classes: IgA, IgM, IgD, IgE and IgG. Immunoglobulin G (IgG) is the highest abundant antibody inserum and extravascular fluids. The extent of serum IgG is related to severity of severaldiseases such as infections, so IgG has great diagnostic worth. Accurate measurementof IgG, needs exact and sensitive diagnostic instruments such as human IgG-specificmonoclonal antibodies. Moreover, targeting of IgG has been useful in treatment of anumber of diseases. According to experimental studies the Fc region of human IgG ishighly immunogenic. Immunoinformatic is a division of immunology uses the computationalbiology for more precise diagnosis of diseases. The aim of this study was determinationof conformational epitopes in the fragment of crystallizable (Fc) fragmentof human IgG by immunoinformatic. Methods: The amino acid residues and third structure of reference human IgG werefound in protein data bank (PDB). Second IgG structure was defined by Phyre2 software(http: //www. sbg. bio. ic. ac. uk/~phyre2/). Conformational epitopes of the Fc fragmentin human IgG were specified by ElliPro (http: //tools. iedb. org/ellipro/) and Disco-Tope (http: //www. cbs. dtu. dk/services/DiscoTope) softwares. Results: In this study two conformational epitopes (one in constant heavy chain 2(CH2) domain and another one common between CH2 and CH3 domains) sited in Fcfragment of human IgG were determined by ElliPro software. Also, two conformationalepitopes (Both common between CH2 and CH3 domains) located to Fc fragment ofhuman IgG were determined by DiscoTope software. Conclusion: In this study a number of conformational epitopes located to Fc fragmentof human IgG were determined by two immunoinformatic softwares (ElliPro and DiscoTope). The epitopes recognized by both softwares were situated in CH2, CH3 or bothof these domains in the human IgG heavy chain. Thus, it seems that CH2 and CH3 domainsof Fc region in human IgG are highly immunogenic. Moreover, ElliPro and DiscoTopesoftwares can be useful tools for identification of epitopes located to Fc fragmentof human IgG.

Background: Accurate detection of deep sleep (Due to the low frequency of the brain signalin this part of sleep, it is also called slow-wave sleep) from awakening increases the sleepstaging accuracy as an important factor in medicine. Depending on the time and cost ofmanually determining the depth of sleep, we can automatically determine the depth of sleepby electroencephalogram (EEG) signal processing. In this paper a new EEG bispectrumbased feature is introduced for deep sleep discrimination. Methods: This cross-sectional study was conducted at Isfahan University of MedicalSciences, Faculty of Advanced Technologies in Medicine, from February to October 2017. In this study a gray scale image was made of electroencephalogram bispectrum amounts andconverted to binary image with Otsu’ s Thresholding. Then the ratio of white bits in theabove of the secondary diagonal to white bits in the down of secondary diagonal (low tohigh frequencies bispectrum rate) is extracted as a new feature. This feature is an effectivemethod for detecting deep sleep from awakening. Results: One of the important methods in biomedical signal processing is the use of the powerspectrum or signal energy. In sleep studies, energy-related features have also been used todetermine the depth of sleep. Low to high frequencies bispectrum rate is able to separate deepsleep from awakening by accuracy of 99. 50 percent, while energy-based features as one of themost important approaches to sleep classification do not have this ability. Conclusion: In this study we show that “ Low to high frequencies bispectrum rate" featurehas this capability to use in sleep staging. It is not used in previous works. The accuracyobtained in deep sleep separation from the awakening with the introduced feature (99. 50percent) is greater than the accuracy obtained by all the energy-based features (Thesimultaneous use of the 6 bands energy leads to 99. 42 percent accuracy). This featureindicates the ratio of the phase coupling at low frequencies to high frequencies and can beused in all cases where the bispectrum is used (such as determining the depth of anesthesia).

Background: Cancer of the endometrium is the most common gynecologic malignancyin western and industrial countries, and is the second most common in developingcountries, therefore it is of special importance. Adenocarcinoma of the endometrium isthe most common type of uterine cancer. The prevalence of endometrial cancer inyoung women under the age of 40 in western country is very low and about 5 percent. The aim of this study was to determine the prevalence of endometrial cancer at age ≤ 40years in our center during 4 years. Methods: In a cross-sectional study, all medical records of patients with endometrialcancer in Ghaem University Hospital, Mashhad, Iran was reviewed to identify women<40 years of age with endometrial cancer, over the course of 4 years, (from 2012 to2015). The risk factors for endometrial cancer, such as obesity, polycystic ovary syndrome(PCO), infertility, and a history of cancer in the family or individual, were collectedin each patient. Clinical features, histological type of endometrial carcinoma, andtherapeutic action also were gathered. Results: A total of 119 patients with endometrial cancer that was admitted in our genecologyoncology center were evaluated. 19 patients (15. 9%) were younger than 40 yearsold. 16 cases (84. 2%) with endometrial adenocarcinoma and 3 (15. 7%) had endometrialstromal sarcoma. The youngest patient was 27 years old and the oldest was 39 years. Sevenpatients (36/8%) had infertility and we don’ t know about fertility condition in 3, becausethey were single. 12 cases (63%) were overweight (BMI≥ 35) and 6 cases (31/5%)had polycystic ovarian disease (PCOD). In 2 patients, there was concomitant ovarian andendometrial cancer. Histology report of both ovaries was endometrioid and both patientswere overweight. Obesity, poly cystic ovary syndrome (PCOD) and Infertility were themost important risk factors for endometrial cancer in young patients. Conclusion: The prevalence of endometrial cancer in young women under the age of40 in our country is so higher than the statistics provided in industrial countries.

Background: Some studies show that frozen shoulder is due to the pathologic changesin the muscles around the shoulder. Measurement of the ultrasonic thickness of a muscleis a method for measuring the muscle changes. There is no study about the reliabilityof measurement of the muscle’ s ultrasonic thickness around the shoulder in patientswith frozen shoulder. The present study aims to investigate the intra-rater reliability ofthe ultrasonic thickness measurement of the supraspinatus, deltoid and upper trapeziusmuscles in women with frozen shoulder and healthy women. Methods: This study was carried out during 4 months (June to October 2017). Twentywomen consisted of 10 patients with frozen shoulder (mean age: 51. 6± 9. 41 years) and 10healthy subjects (mean age: 35. 5± 8. 22 years) participated in this study. The patients fromsome clinics and hospitals in Tehran, and healthy subjects consisted of some personals andstudents in the School of Rehabilitation of Shahid Beheshti university of Medical Sciencesparticipated in the present study. Measurements of ultrasonic thickness of the upper trapezius, supraspinatus and deltoid muscles in rest position carried out by the same rater two timesin 48 hours. Ultrasonography instrument with linear probe (frequency: 7. 5 MHz) were usedfor measurement of muscle thickness in millimeter. Results: Reliability of the ultrasonic measurements of the muscle thickness in patientsand healthy subjects was respectively as follow: The upper trapezius muscle (0. 81, 0. 81), the supraspinatus muscle (0. 90, 0. 92) and the middle deltoid muscle (0. 93, 0. 96). The reliability of the ultrasonic measurements of the muscle thickness for the uppertrapezius muscle and the supraspinatus muscle was higher in healthy subjects comparedto the patients with frozen shoulder. The reliability of the ultrasonic measurements ofthe middle deltoid thickness for the patients and healthy subjects was similar. Conclusion: It seems that ultrasonography is a reliable method for measuring the thicknessof the muscles around the shoulder in patients with frozen shoulder and healthy subjects.

Background: With aging, muscles strength decrease. Balance disorder is one of thecommon aging problems which can cause falls and serious injuries. The purpose of thisstudy was to present a model along with the determinants of balance status in the elderly. Methods: This cross-sectional study is part of a cohort study, "investigation of thehealth status of elderly in Amirkola City", which was performed on 1616 old peopleaged≥ 60 years, (response rate 72 %). The baseline data of this study were collected inthe Center for Social Determinants of Health (SDH) Research Centre of the BabolUniversity of Medical Sciences during March 2011 to July 2012. We considered theage, sex, physical activity, quadriceps muscle strength, daily activity, serum level ofvitamin D, BMI, number of comorbidities and orthostatic hypotension as independentvariables. Using the results of Berg balance test, the balance status of participants (asdependent variable) was categorized into two groups: score between 41-56 as normal(low risk of fall) and score < 41 as balance disorder (medium or high risk of fall). Then, the association of independent variables with balance status were evaluated in thelogistic regression model. Results: The mean and standard deviation of participants' age was 69. 37± 7. 6 years, 54. 7% of them were men and 7. 5% of them had balance disorder. The odds ratio ofmedium or high falls in women to men, the number of comorbidities, having strongquadriceps to weak muscles, seniors aged 80 years and over, to 60-69, seniors with highphysical activity to low physical activity, daily activities were (OR=2. 1, 95%CI: 1. 0-4. 1), (OR=1. 7, 95%CI: 1. 0-2. 9), (OR=0. 05, 95%CI: 0. 0-0. 4), (OR=5. 0, 95%CI: 2. 3-10. 6), (OR=0. 3, 95%CI: 0. 1-0. 6), (OR=14. 4, 95%CI: 3. 4-60. 4), respectively and statisticallysignificant. The odds ratio of fall for vitamin D, orthostatic blood pressure and BMIvariables did not show any statistically significant differences. The results of theanalysis showed that the balance in all age groups in men was better than women. Conclusion: Weak quadriceps, aging, being a woman and having comorbidities are themost important risk factors of balance disorder in the elderly.

Background: Hospital accreditation is a systematic external evaluation of a hospital’ sstructures, processes and results by an independent professional accreditation body usingpre-established optimum standards. This study aimed to evaluate the hospital accreditationsystem. Methods: This descriptive and cross-sectional study was carried out between November2015 and February 2016 using a questionnaire covering accreditation standards, methods, surveyors, implementation and effects. The study population consisted of 161 hospitalmanagers in Tehran province, Iran. Overall 87 hospital managers were surveyedthrough stratified random sampling. Results: The mean score of managers’ satisfaction of hospital accreditation system was2. 93 out of 5 score. About 16 percent of managers were satisfied with the hospital accreditationsystem. Hospital managers were most satisfied with accreditation effects(3. 14) and least satisfied with accreditation standards (2. 54). Hospital managers weresatisfied with surveyors’ attitude, number of survey days and the number of surveyorsin the accreditation team. They were least satisfied with the lack of consistency amongsurveyors, lack of transparency of standards, too many standards and low competencyof surveyors. Hospital managers mostly believed that accreditation should be done byMinistry of Health, compulsory, and every two years. About 97 percent of managersagreed that self-assessment is necessary and beneficial prior to the accreditation survey. Conclusion: Accreditation was moderately successful in Tehran hospitals. Accreditationhad the most effect on improving patient safety and meeting patients' rights andleast effect on improving employees' job satisfaction and involving doctors in qualityimprovement. Strengthening Iran hospital accreditation system, training managers andemployees on implementing standards, and providing necessary resources make it possibleto achieve accreditation goals.

Background: Association of Addison's disease with connective tissue diseases such asscleroderma and Sjogren have been rarely reported. Anti-centromere antibody (ACA)has been associated with exocrine gland dysfunction in anti-Ro, anti-La negativeSjogren’ s syndrome and may be one of the causes of xerostomia in community. Thepurpose of this article was to introduce a rare case of scleroderma-Sjogren intermediatephenotype with positive anti-centromere antibody in a known case of Addison’ s diseaseadmitted for dental caries and xerostomia. Case Presentation: A 29-year-old woman with Addison’ s disease referred to a dentalclinic due to recurrent dental caries. Addison’ s disease was confirmed by low basalserum cortisol level and unresponsive serum cortisol level to adrenocorticotropin hormone(rapid ACTH stimulation test). Signs of xerostomia, xerophthalmia, Raynaud’ sphenomenon, gastro-esophageal reflux, masked face, osteoporosis, positive anticentromereantibody, negative anti-Ro and anti-La antibodies and failure to match thepathology of the minor salivary gland of lip with Sjogren's disease were found. Thediagnosis of scleroderma-Sjogren intermediate phenotype was raised with consideringsome of the symptoms of scleroderma and Sjogren and not the exact classification criteriafor each of these two diseases. Hydroxychloroquine, fluoride and Biotene® mouthwash(Laclede, Inc., CA, USA) (oral moisturizing saliva), chewing gum containingxylitol plus artificial tear droplet was prescribed. Drinking plenty of fluids was recommended. Due to gastroesophageal reflux and osteoporosis, Pantoprazole and CinnoPar® (Cinnagen, Iran) (parathyroid hormone analogue) plus calcium and vitamin D supplementswas administered. Regarding adrenal insufficiency, Prednisolone and Fludrocortisonewere continued. Conclusion: For evaluation of recurrent dental caries, especially in patients with autoimmunedisease, anti-centromere antibody may be useful to identify the cause of drymouth, as well as early detection of limited scleroderma or scleroderma-Sjogren intermediatephenotype.